DOI: http://dx.doi.org/10.18203/2349-2902.isj20194451

Annular pancreas with choledocholithiasis in an adult male patient: a case report

Ilija Milev, Panche Karagjozov, Aleksandar Mitevski, Marjan Mihailov

Abstract


Annular pancreas is very rarely presented with a clinical picture of obstructive jaundice, usually due to some biliopancreatic malignancy rather than choledocholithiasis which make our case unique. We are presenting a 60-year-old male patient with a 6 mounts old medical history of right upper quadrant pain and intermittent jaundice. On ultrasonography a common bile duct stone was detected with dilatation of the biliary tree and gallstones with edematous wall of the gallbladder. On gastroscopy narrowing of the duodenum was registered. On ERCP the papilla Vateri could not be cannulated and there was a substantial amount of retained food in the duodenal bulb and antral part of the stomach. MRCP showed extensive dilatation of the whole biliary tree from several stones in the distal part of the common bile duct. At the operation there was a ring of pancreatic tissue about 2 cm wide that surrounded the second portion of the duodenum. The operation proceeded with choledochotomy, choledocholythotomy, L-L choledocho-duodenostomy and partial resection of the pancreatic ring. After three mounts the patient had gain weight, had no pain or any other symptoms and control gastroscopy showed normal finding.


Keywords


Annular pancreas, Jaundice, Choledocholithiasis

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References


Tiedemann F. Uber die Verschiedenheiten des Ausführungsganges der Bauchspeicheldruse bei den Menschen und Saugetieren. Dtsch Arch Physiol. 1818;4:403.

Ecker A. Bildungsfehler des Pankreas und des Herzens. Z Rat Med. 1862;14:354.

Vidal E. ProcesVerbaux, Memoires et discussion (Assosc Franc Chiru). 18e Congress de Chirugie, Paris. 1905;18:739.

Sandrasegaran K, Patel A, Fogel EL, Zyromski NJ, Pitt HA. Annular Pancreas in Adults. Am J Roentgenol. 2009;193:455-60.

Thomford NR, Knight PR, Pace WG, Madura JA. Annular pancreas in the adult: selection of operation. Ann Surg. 1972;176(2):159-62.

Fu PF, Yu JR, Liu XS, Shen QY, Zheng SS. Symptomatic adult annular pancreas: report of two cases and a review of the literature. Hepatobiliary Pancreat Dis Int. 2005;4(3):468-71.

Zyromski NJ, Sandoval JA, Pitt HA, Ladd AP, Fogel EL, Mattar WE, et al. Annular pancreas: dramatic differences between children and adults. J Am Coll Surg. 2008;206(5):1019-25.

Wang D, Kang Q, Shi S, Hu W. Annular pancreas in China: 9 years' experience from a single center. Pediatr Surg Int. 2018;34(8):823-7.

Nagpal SJS, Peeraphatdit T, Sannapaneni SK, Sharma A, Takahashi N, Kendrick ML, et al. Clinical spectrum of adult patients with annular pancreas: Findings from a large single institution cohort. Pancreatology. 2019;19(2):290-5.

Wani AA, Maqsood S, Lala P, Wani S. Annular Pancreas in Adults: A Report of Two Cases and Review of Literature. JOP. J Pancreas (Online). 2013;14(3):277-9.

Kandpal H, Bhatia V, Garg P, Sharma R. Annular pancreas in an adult patient: diagnosis with endoscopic ultrasonography and magnetic resonance cholangiopancreatography. Singapore Med J. 2009;50(1):29.

Patra DP, Basu A, Chanduka A, Roy A. Annular Pancreas: A Rare Cause of Duodenal Obstruction in Adults. Indian J Surg. 2011;73(2):163-5.

Sirasanagandla SR, Nayak SB, Bhat KMR. A Rare Congenital Anomaly of the Pancreas: A Cadaveric Case Report. JOP. J Pancreas (Online). 2013;14(4):454-7.

Jarry J, Wagner T, Rault A, Cunha AS, Collet D. Annular Pancreas: A Rare Cause of Acute Pancreatitis. JOP. J Pancreas (Online). 2011;12(2):155-7.

Noh TH, Lee SE, Park JM. Laparoscopic treatment of annular pancreas in adults: report of a case. Korean J Hepatobiliary Pancreat Surg. 2012;16(1):43-5.

Moon SB. Annular pancreas in an 11-year-old girl: a case report. Int Med Case Rep J. 2017;10:65-7.

Moodley S, Hegarty M, Thomson SR. Annular pancreas. South Afr Med J. 2004;94(1):28.

Kim SS, Shin HC, Hwang JA. Various Congenital Abnormalities and Anatomic Variants of the Pancreas: A Pictorial Review. J Belg Soc Radiol. 2019;103(1):39.

Lecco TM. Zur morphologie des pankreas annulare. Sitzungsberichte der Heidelberger Akademie der Wissenschaften. 1910;119:391-406.

Baldwin WM. A specimen of annular pancreas. Anat Rec. 1910;4:299-304.

Patidar Y, Arora A, Mukund A, Dev A. Portal Annular Pancreas: An Under-Reported Pancreatic Anomaly. J Surg Tech Case Rep. 2012;4(2):140-1.

Russo A, Armand-Ugon G. Annular pancreas: case report and review of the literature. Eur J Anat. 2015;19(2):197-200.

Morrell MT, Keynes WM. Annular pancreas and jaundice. Br J Surg. 1970;57: 814-6.

Alborzi F, Daryani NE, Roshan N, Mami M, Ale taha N. Annular Pancreas Presenting with Painless Jaundice: A Case Report and Review of Literature. Govaresh. 2015;20(3):208-12.

Tewari M, Verma A, Shukla HS. Carcinoma of the Ampulla of Vater Associated with Annular Pancreas. Indian J Surg. 2016;78(5):409-10.

Ladd AP, Madura JA. Congenital duodenal anomalies in the adult. Arch Surg. 2001;136(5):576-84.

McGuinness CL, Choy A, Gajraj H, Chilvers AS. Stapling technique for annular pancreas. Br J Surg. 1993;80(6):758.

Mahdi B, Selim S, Hassen T, Mongi MM, Fadhel CM, Fathi C, et al. A rare cause of proximal intestinal obstruction in adults - annular pancreas: a case report. Pan Afr Med J. 2011;10:56.